Lymphadenectomy during pulmonary metastasectomy: Impact on survival and recurrence

• Published in: Journal of surgical oncology 2019-09, Vol.120 (4), p.768-778
• Main Authors: Londero, Francesco, Morelli, Angelo, Parise, Orlando, Grossi, William, Crestale, Sara, Tetta, Cecilia, Johnson, Daniel M., Livi, Ugolino, Maessen, Jos G., Gelsomino, Sandro
• Format: Article
• Language: English
• Subjects: Aged; Cancer surgery; Carcinoma, Non-Small-Cell Lung - mortality; Carcinoma, Non-Small-Cell Lung - pathology; Carcinoma, Non-Small-Cell Lung - surgery; Female; Follow-Up Studies; Humans; Lung cancer; lung metastases; Lung Neoplasms - mortality; Lung Neoplasms - pathology; Lung Neoplasms - surgery; lung resections; Lymph Node Excision - mortality; lymphadenectomy; Male; Metastasectomy - mortality; Metastasis; Middle Aged; Neoplasm Recurrence, Local - mortality; Neoplasm Recurrence, Local - pathology; Neoplasm Recurrence, Local - surgery; Pneumonectomy - mortality; Prognosis; Risk Factors; Survival Rate
• ISSN: 0022-4790; 1096-9098
• DOI: 10.1002/jso.25635

Background and Objectives: Lymphadenectomy during pulmonary metastasectomy (PM) is widely carried out. We assessed the potential benefit on patient survival and tumor recurrence of this practice. Methods: One hundred eighty‐one patients undergoing a first PM were studied. Eighty‐six patients (47.5%) underwent lymphadenectomy (L+ group) whereas 95 (52.5%) did not undergo nodal harvesting (L−group). Main outcomes were overall survival (OS) and disease‐free survival (DFS). Median follow‐up was 25 months (interquartile range [IQR], 13‐49). Results: At follow‐up 84 patients (46.4%) died, whereas 97 (53.6%) were still alive with recurrence in 78 patients (43%). There was no difference in 5‐year survival (L+ 30.0% vs L− 43.2%; P = .87) or in the 5‐year cumulative incidence of recurrence (L + 63.2% vs L−80%; P = .07) between the two groups. Multivariable analysis indicated that disease‐free interval (DFI) less than 29 months (P